CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 679 447.500000 16647.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 96 67.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 766 2234.750000 83067.4000 37.1708
Subtotal (Total Children Is Unduplicated) 1161 2749.750000 99714.4000 36.2631
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 18.000000 873.0000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 33.000000 2486.9600 75.3624
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 75 148.500000 10009.4600 67.4038
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 2 2.000000 84.8200 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 7 14.000000 1007.4400 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 40 36.750000 1837.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 118 117.750000 5887.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 9.750000 487.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 181 83.000000 4150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 84 106.500000 5325.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 297 152.250000 7612.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 37 40.500000 1990.0000 49.1358
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 116 43.250000 2162.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 54 65.000000 3250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 190 86.250000 4312.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 546 1735.750000 50.0000 0.0288
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 83.000000 4170.0000 50.2410
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 44.000000 2224.0000 50.5455
EPIC-99601-Early Steps Professional Development Fee 404 1365.000000 20472.0000 14.9978
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 178 751.000000 9012.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 90.000000 6476.4000 71.9600
OCCT-97530GO-OT SESSION BY LICENSED OT 5 6.000000 441.1200 73.5200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 7 15.000000 1079.4000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 13 71.250000 5127.1500 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.750000 269.8500 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 124.000000 8923.0400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 17.750000 1277.2900 71.9600
Subtotal (Total Children Is Unduplicated) 746 5075.500000 98421.2300 19.3914
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Total 7973.750000 208145.0900 26.1038
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Number of Children (Unduplicated) With at Least One Service 1361
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Center 54
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 260 191.250000 7833.3700 0.0000
S 26 35.500000 230.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9835 7719.500000 199015.2700 0.0000
Other 45 27.500000 1066.4500 0.0000
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Total 10166 7973.750000 208145.0900 0.0000